---
type: source
title: "2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults"
author: "American Heart Association / American College of Cardiology Joint Committee"
url: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001356
date: 2025-08-01
domain: health
secondary_domains: []
format: journal article
status: unprocessed
priority: medium
tags: [hypertension, blood-pressure, guidelines, DASH, lifestyle, AHA, ACC, 2025-guideline]
---

## Content

The comprehensive 2025 US hypertension clinical guidelines, a major update from the 2017 guidelines. Multi-society guidelines with 14 co-authoring organizations.

**Key threshold changes:**
- Reaffirmed the 2017 AHA/ACC threshold of ≥130/80 mmHg for Stage 1 hypertension (did NOT revert to the JNC-7 140/90 definition still used in some international guidelines)
- Treatment goal: <130/80 mmHg for most adults, with encouragement to achieve <120/80 mmHg
- This keeps the US threshold more aggressive than 2018 ESC guidelines (which use 140/90)

**Lifestyle recommendations (strongly emphasized):**
- Heart-healthy eating pattern: DASH diet as primary recommendation
- Reduce sodium intake
- Increase dietary potassium
- Physical activity
- Stress management
- Reduce/eliminate alcohol

**Clinical significance for SDOH theme:** The guideline explicitly prioritizes DASH dietary patterns as a first-line intervention, before or alongside pharmacotherapy. This is the clinical validation for the food-as-medicine approach — the leading cardiology guidelines say dietary change is a primary treatment, not an adjunct. However, the guideline doesn't address how to provide dietary access to food-insecure patients — it assumes patients can implement DASH, which requires food access.

**Projected medication impact:** A companion PMC analysis projects this guideline will increase antihypertensive medication use significantly — the <130/80 threshold would bring millions of additional adults into treatment range.

Published: Circulation (AHA), published online summer 2025; also JACC companion publication (JACC 2025 Vol 85 #12).

## Agent Notes

**Why this matters:** The 2025 AHA/ACC guideline is the reference document for US hypertension management. Its emphasis on DASH dietary patterns as first-line establishes the clinical legitimacy of food-as-medicine approaches. But the guideline doesn't solve the food access problem — it prescribes a DASH diet to patients who may not be able to afford or access DASH-appropriate foods. This is the clinical guideline-SDOH gap: best-practice dietary advice disconnected from the food environment reality.

**What surprised me:** The guideline maintained the 130/80 threshold rather than revising upward (some expected a reconciliation with the 2018 ESC 140/90 standard). The <120/80 encouragement is new — pushing treatment targets even lower. This will expand the treated hypertension population substantially.

**What I expected but didn't find:** Any language about SDOH screening or food insecurity as a clinical component of hypertension management. The guideline appears to focus on the clinical and lifestyle prescription without addressing the structural barriers to lifestyle compliance.

**KB connections:**
- From Session 16: AHA Hypertension 57-study SDOH review — five factors predicting non-control — this guideline doesn't address those five factors
- Kentucky MTM: food-as-medicine achieves guideline-level BP reduction (-9.67 mmHg) — but only during active program
- [[healthcare AI creates a Jevons paradox because adding capacity to sick care induces more demand]] — aggressive threshold expansion (130/80 → treatment) may expand sick-care demand without addressing food environment

**Extraction hints:**
- This is a reference document, not a primary research study — extract as a context anchor for hypertension claims
- Key extractable fact: "2025 US guidelines reaffirmed ≥130/80 threshold and endorsed DASH as primary lifestyle intervention, but contain no structural food access guidance despite food insecurity's independent prediction of hypertension non-control"
- The gap between guideline recommendation (eat DASH) and food access reality (SNAP cuts) is a claim-worthy tension

**Context:** This guideline will drive clinical practice for the next 5-7 years. It is the clinical standard against which all hypertension interventions are evaluated.

## Curator Notes (structured handoff for extractor)

PRIMARY CONNECTION: [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]

WHY ARCHIVED: Establishes the clinical reference point — what the guideline says is best practice for hypertension — against which the food-as-medicine evidence and SDOH gap can be measured.

EXTRACTION HINT: This is a landmark guideline, not a study. The extractable claim is the tension: "2025 hypertension guidelines recommend DASH dietary patterns as primary lifestyle intervention but contain no structural guidance for food-insecure patients who lack DASH-accessible food environments." Medium priority for extraction — the guideline content itself is background; the gap is the claim.
